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To Your Good Health: Chronic Fatigue Syndrome Has a New Name, Possibly a New Test

Dear Dr. Roach: For two years, I have had symptoms of chronic fatigue syndrome. Like many of my fellow sufferers, I continually feel bad, but no test can confirm my diagnosis.

Because of this and other factors, I am looking at “psychosomatic illness” as a cause. CFS would lend itself to such a diagnosis. Any information you could offer would be appreciated. — R.S.

Answer: The term “psychosomatic” simply means “mind and body.” It is clear to me that there is no significant disease of the body that does not affect the mind, at least to some extent. And there is no serious condition that affects the mind where the body does not suffer in some way. From that perspective, all diseases are psychosomatic.

However, the term is used in everyday language to describe a person with nothing wrong with the body, whose symptoms are due entirely to emotions. It’s very frustrating, since it implies that a person’s physical symptoms are due to some weakness in his or her character.

This is certainly not the case with chronic fatigue syndrome. The recommendation now is to call it “systemic exertion intolerance disease,” which is a better explanation of the condition. The Institute of Medicine proposed new criteria for diagnosing SEID (one place to read about this report is at https://tinyurl.com/SEID-IOM). While there is not yet a blood test to confirm the diagnosis, researchers at Stanford recently reported a pattern of inflammatory markers that may help confirm and quantify the severity of this condition.

A full description of this complex illness is beyond the scope of this column. Although there is no cure, there are a variety of treatments available. I must caution against the over-aggressive use of exercise programs, which can worsen symptoms.

Answer: There are several kinds of fitness trackers, ranging from devices that measure activity (such as steps and stairs) to devices that also measure heart rate and precise location via GPS. They can be worn as a bracelet or watch, or carried in the pocket or elsewhere. None of this electronic activity is in any way harmful.

I have seen only two kinds of health risks from trackers. The first is a skin reaction to the device itself. This happens in people who are sensitive, and it’s not uncommon. It may happen right away or as the bracelet wears.

The second is that some people overdo it. These devices are designed to help motivate people to more activity, and that effect is variable: Some people have no effect; many people get a benefit; and a few people overdo it.

Dear Dr. Roach: My 52-year-old sister was diagnosed with cirrhosis of the liver due to alcohol. She has significant financial resources and gold-standard health care. Her liver has failed to bounce back. This month, she was placed on a liver-transplant list. How long can my sister live with alcoholic liver cirrhosis while awaiting a liver transplant? If she complies with transplant protocol (no alcohol, no salt, counseling, etc.), how likely is it that any alcoholic receives a liver donation? The doctors say her MELD score is 25. Could her liver recover so that she won’t need a transplant? — S.H.

Answer: I am sorry to hear about your sister. Prolonged, heavy alcohol use can lead to cirrhosis, which is an irreversible condition of liver damage. Stopping alcohol use usually prevents progression of liver disease. Liver disease is estimated by the MELD score. Less than 15 is mild; greater than 35 is the most severe. It is unlikely that her liver would recover with this degree of damage.

According to the most up-to-date statistics from the U.S. Organ Procurement and Transplantation Network, there are 14,000 people waiting for a liver transplant now. People with more severe liver disease are higher priority for the very limited number of organs that become available. As of December 2016, the median wait time for a liver transplant for a person with a MELD score between 15 and 34 was about eight months, meaning that half of people on the waiting list will be transplanted within eight months, and the other half will still be waiting. About 10 percent of people between ages 50 and 64 die each year waiting for a transplant.

People with acute liver failure, from whatever cause, are more likely to die awaiting transplant than people who are on the transplant list for other causes, including alcoholic liver disease, hepatitis C or other causes. The vast majority of deaths on the waiting list are in people whose MELD score is above 35, which is why they are at such high priority for an organ.

It used to be the case that people with alcoholic liver disease were considered lower priority for transplant. However, the data show that liver transplantation is just as effective in selected patients with alcoholic liver disease as any other cause. However, abstinence from alcohol is an expectation for people on the transplant list. Many centers use a six-month rule prior to listing a patient; however, the six-month rule is somewhat arbitrary, and the earlier a person is listed, the better the likelihood of getting an organ. In studies, between 11 percent and 30 percent of people will drink after transplant, but only 5 percent had “excessive” drinking.

Dr. Roach Writes: A recent column on lip burning and pain generated many suggestions from readers with similar symptoms. Advice included: repeated applications of zinc oxide cream or petrolatum (Vaseline); B-12 tablets (get your level tested first, though); avoiding triggers, such as sodium lauryl sulfate (present in many toothpastes) and fruits like pineapple and melon. As always, I appreciate my readers who take the time to write in, and I am touched by the desire to help others with their experiences.